Practice guidelines for necropsy: time for action.

The necropsy is a professional activity which requires extensive knowledge and technical ability in order to identify and interpret important findings within a wide range of clinical contexts. The central role of the medicolegal necropsy in the investigation of death necessitates the highest possible standards of practice. Similarly, the clinical necropsy represents one of the few situations when clinicians elect to submit their management of cases to assessment by other doctors. This issue of the Journal contains yet another study describing a high rate of discrepancies between clinical diagnoses and necropsy findings.' Such studies are useful in that they demonstrate the amount of data that can be obtained from high quality necropsies. Pathology has been at the forefront of the introduction of quality control into medicine and it must surely be time for formal quality control in necropsy practice. Practice guidelines represent recommendations that identify a range ofvoluntary strategies for the management of a specific problem and that also allow for practice variation due to individual circumstances.2 Standards differ from guidelines in that practice variation is not expected. Variation in necropsy practice is to be expected as each necropsy involves the incorporation of substantial patient specific information and consequently practice guidelines rather than standards are desirable and could be achievable if formulated through the framework of the appropriate professional pathology organisations.2